1 New Paragraphs; Standards for Accident and Health Insurance; Minimum Standards for Claim Review. Amend RSA 415-A:4-a by inserting after paragraph V the following new paragraphs:

VI. Any carrier requiring prior authorization or a pre-service claim to be filed for a covered benefit or service deemed medically necessary by a licensed health care provider which delays a claimant's receipt of the covered benefit or service and results in harm to the claimant, will be considered to have engaged in an unfair claim settlement practice by an insurer under RSA 417:4, XV.

VII. In any request for a pre- or post-service claim or benefit determination by a claimant or a physician, if the carrier fails to follow the provisions of this statute or denies a medical benefit claim for a covered service that a licensed health care provider as defined in RSA 420-J:3, XXI has determined to be medically necessary, without reasonable grounds for doing so, it will be considered an unfair claim settlement practice by an insurer under RSA 417:4, XV.

2 New Section; Private Right of Action. Amend RSA 415-A by inserting after section 7 the following new section:

415-A:7-a Private Right of Action. Any person injured by an action or unfair claim settlement practice declared unlawful under this chapter may bring an action for damages and for such equitable relief, including an injunction, as the court deems necessary and proper. If the court finds for the plaintiff, recovery shall be in the amount of actual damages or $1,000, whichever is greater. If the court finds that the use of the method of competition or the act or practice was a willful or knowing violation of this chapter, it shall award as much as 3 times, but not less than 2 times, such amount. In addition, a prevailing plaintiff shall be awarded the costs of the suit and reasonable attorney's fees, as determined by the court. Any attempted waiver of the right to the damages set forth in this paragraph shall be void and unenforceable. Injunctive relief shall be available to private individuals under this chapter without bond, subject to the discretion of the court. Upon commencement of any action brought under this section, the clerk of the court shall mail a copy of the complaint or other initial pleadings to the insurance commissioner and, upon entry of any judgment or decree in the action, shall mail a copy of such judgment or decree to the commissioner.

3 Effective Date. This act shall take effect January 1, 2021.

1 New Paragraphs; Standards for Accident and Health Insurance; Minimum Standards for Claim Review. Amend RSA 415-A:4-a by inserting after paragraph V the following new paragraphs:

VI. Any carrier requiring prior authorization or a pre-service claim to be filed for a covered benefit or service deemed medically necessary by a licensed health care provider which delays a claimant's receipt of the covered benefit or service and results in harm to the claimant, will be considered to have engaged in an unfair claim settlement practice by an insurer under RSA 417:4, XV.

VII. In any request for a pre- or post-service claim or benefit determination by a claimant or a physician, if the carrier fails to follow the provisions of this statute or denies a medical benefit claim for a covered service that a licensed health care provider as defined in RSA 420-J:3, XXI has determined to be medically necessary, without reasonable grounds for doing so, it will be considered an unfair claim settlement practice by an insurer under RSA 417:4, XV.

2 New Section; Private Right of Action. Amend RSA 415-A by inserting after section 7 the following new section:

415-A:7-a Private Right of Action. Any person injured by an action or unfair claim settlement practice declared unlawful under this chapter may bring an action for damages and for such equitable relief, including an injunction, as the court deems necessary and proper. If the court finds for the plaintiff, recovery shall be in the amount of actual damages or $1,000, whichever is greater. If the court finds that the use of the method of competition or the act or practice was a willful or knowing violation of this chapter, it shall award as much as 3 times, but not less than 2 times, such amount. In addition, a prevailing plaintiff shall be awarded the costs of the suit and reasonable attorney's fees, as determined by the court. Any attempted waiver of the right to the damages set forth in this paragraph shall be void and unenforceable. Injunctive relief shall be available to private individuals under this chapter without bond, subject to the discretion of the court. Upon commencement of any action brought under this section, the clerk of the court shall mail a copy of the complaint or other initial pleadings to the insurance commissioner and, upon entry of any judgment or decree in the action, shall mail a copy of such judgment or decree to the commissioner.

3 Effective Date. This act shall take effect January 1, 2021.